脊髓损伤近期股骨远端和胫骨近端骨密度的变化

Changes of bone mineral density in distal femur and proximal tibia after spinal cord injury

目的探讨发生脊髓损伤(SCI)后1年内股骨远端(DF)和胫骨近端(PT)骨密度(BMD)的变化。方法纳入36例健康志愿者(对照组)和36例12个月内发生SCI的患者,36例SCI患者根据接受DXA扫描时发生SCI的时间分为3个亚组(SCI后6周SCI甲组15例,SCI后7周-3个月SCI乙组10例和SCI后4-12个月SCI丙组11例)。采用双能X线骨密度仪测量所有受试者DF、PT、股骨颈和髋部的BMD。比较36例SCI患者中8例SCI后3个月和6个月的DXA检测结果。结果SCI后6周内SCI甲组PT处BMD低于对照组(P<0.05);SCI后7周-3个月SCI乙组DF和PT处的BMD低于对照组(P<0.05);SCI后4-12个月SCI丙组DF、PT、股骨颈和髋部BMD均低于对照组(P<0.05)。8例SCI患者6个月后DF和PT处的BMD均较SCI后3个月低,差异具有统计学意义(P<0.05);股骨颈和全髋BMD较SCI后3个月差异无统计学意义(P>0.05)。结论SCI第1年PT和DF部位BMD的下降明显早于髋部,建议早期对SCI患者DF、PT处BMD进行监测,以便早期制定干预措施,降低PT和DF部位的骨折风险。

Objective To explore the changes of bone mineral density(BMD)of distal femur(DF)and proximal tibia(PT)within one year after spinal cord injury(SCI).Methods 36 healthy volunteers(control group)and 36 patients with SCI within 12 months were included.36 patients with SCI were divided into three subgroups according to the time of SCI during DXA scanning(15 cases in SCI a group 6 weeks after SCI,10 cases in SCI B group 7 weeks-3 months after SCI and 11 cases in SCI C group 4 months-12 months after SCI).The BMD of DF,Pt,femoral neck and hip of all subjects were measured by dual energy X-ray absorptiometry.The DXA results of 8 of 36 SCI patients 3 months and 6 months after SCI were compared.Results The BMD of Pt in SCI a group was lower than that in the control group within 6 weeks after SCI(P<0.05);BMD at DF and Pt in SCI group B was lower than that in the control group 7 weeks-3 months after SCI(P<0.05);BMD at DF,Pt,femoral neck and hip in SCI group C was lower than that in the control group 4-12 months after SCI(P<0.05).BMD at DF and Pt in 8 patients with SCI after 6 months were lower than that in 3 months after SCI,and the difference was statistically significant(P<0.05);there was no significant difference in BMD of femoral neck and total hip compared with 3 months after SCI(P>0.05).Conclusion The decline of BMD at Pt and DF in the first year of SCI was significantly earlier than that at hip.It is suggested to monitor BMD at DF and Pt in patients with SCI early,so as to formulate early intervention measures to reduce the risk of fracture at Pt and DF.